Research Articles & Publications

This is a list of research articles and material produced by the team at the Melbourne Centre for ISTDP

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Mystery pain: Is it all in our heads?

Life Matters - ABC Radio National interview with Dr Dion Nowoweiski.

Producer: Cassandra Steeth

CASE STUDY: ISTDP FOR SEVERE MUSIC PERFORMANCE ANXIETY

This paper provides a case study of a brief ISTDP treatment of a professional musician with severe performance anxiety.

ISTDP FOR SEVERE BEHAVIOURAL DISORDERS

In this article we describe the use of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for people with a broad range of self-destructive behavioural problems including substance abuse, gambling, compulsive sexual activity, poor impulse control, violence, temper tantrums, self- harm, risk-taking, and the spectrum of eating disorder related symptoms. In this paper we will have a particular focus on patients with Eating Disorders (ED). We will define the different types of ED patients according to the metapsychology developed by Davanloo (1990, 2000). We will illustrate how unconscious mechanisms produce and perpetuate the self-destructive behaviours seen in these patients. Additionally, we will clarify how ISTDP may be an effective aid in working with these patients when behaviours are removed while psychopathological forces are still in operation. We will emphasise the technique as it applies to patients with severe fragile character structure/borderline organisation. We will also discuss unique treatment and therapist issues in working with behaviourally disordered patients.

WEBCONFERENCE SUPERVISION

The advent of readily accessible, inexpensive webconferencing applications has opened the door for distance psychotherapy supervision using video recordings of treated clients. Although relatively new, this method of supervision is advantageous given the ease of use and low cost of various Internet applications. This method allows periodic supervision from point to point around the world with no travel costs and no long gaps between direct training contacts. Webconferencing permits face-to-face training so the learner and supervisor can read each other's emotional responses while reviewing case material. It allows group learning from direct supervision to complement local peer-to-peer learning methods. In this article we describe the relevant literature on this type of learning method, the practical points in its utilization, its limitations and its benefits.

DAY PROGRAM FOR EATING DISORDERS

Day treatment programs (DTP) for eating disorders are being recognised as having therapeutic benefits. However, research is needed to evaluate the effectiveness of DTP to establish their validity. This article reports on the evaluation of a pilot DTP in an Australian mental health setting, which utilised an integrative approach com- bining evidence-based treatments such as dialectical-behavioural therapy and inten- sive short-term dynamic psychotherapy offered in a group-based setting. Comparison of pre- and post-treatment data outcome measures for eating disorder pathology and comorbid symptoms was undertaken. Patient satisfaction was also evaluated using qualitative methods. Results indicated a significant reduction in depressive symp- toms post-treatment, along with a high degree of satisfaction with the treatment. Limitations of this study, along with the implications of the findings and directions for future research, are discussed.

REVIEW OF PSYCHODYNAMIC PSYCHOTHERAPY NEUROIMAGING STUDIES

The clinical efficacy of psychodynamic psychotherapy (PDT) has undergone extensive study and review. Recently, re- searchers have studied the effects of this treatment on brain metabolic or synaptic activity, but the collective findings have never been reviewed. The objective of this review was to describe the findings of all neuroimaging studies of any form of PDT treatment. An extensive literature search through databases along with surveying of research groups were undertaken to acquire all available published studies. Eleven series were included in the final sample, consisting of 2 randomized controlled trials, 5 controlled trials and 4 case series, altogether involving 210 people: 94 healthy controls and 116 people with mood disorders, panic disorder, so- matoform disorders and borderline personality disorder. A variety of neuroimaging techniques were used to examine regional metabolic activity and synaptic neurotransmission before and after treatment. The common finding was nor- malization of synaptic or metabolic activity in limbic, mid- brain and prefrontal regions, occurring in association with improved clinical outcomes. PDT has demonstrable effects on brain function in diverse clinical populations as evidenced by a modest group of mixed neuroimaging studies.